1: Should Seniors Be Starting a Statin to Stay Heart Healthy?

A double-blind placebo-controlled RCT of 9K older adults aged 70+ without cardiovascular disease found that 40 mg of atorvastatin daily led to a lower risk of major cardiovascular events after ~6 years compared with placebo (HR, 0.70; 95% CI, 0.61–0.82; P<0.001). However, atorvastatin did not result in longer disability-free survival among older adults in the community without clinical cardiovascular disease. More research is needed to determine whether statins are an appropriate strategy for primary prevention in older adults.

2: Timely Sepsis Care: Read Between the Signs

A cohort study of 29K adults presenting with community-onset bacterial sepsis found that symptoms such as prehospital fever and GI symptoms were associated with significantly faster antibiotic treatment. Additionally, timely initiation of antibiotics was associated with significantly reduced 30-day mortality after adjusting for specific patient characteristics. These findings emphasize the need to pay close attention to patients with less obvious clinical presentations to achieve more timely recognition and treatment of sepsis.

3: Taking Anxiety to Heart

A randomized clinical trial of 375 patients discharged from the emergency department with low-risk chest pain looked at the efficacy of a telehealth-delivered CBT program to reduce anxiety. The internet-based CBT produced a 1.22-point greater improvement on the GAD-7 anxiety score compared with primary care referral. Additionally, global anxiety also improved in the CBT groups compared with primary care referral. Talk about a weight off your chest!

Patches, gum, lozenges, inhalers, sprays and nicotine tablets are all forms of nicotine replacement therapy (NRT), while prescription medications such as varenicline and bupropion offer additional options for helping patients quit smoking. And now, oral nicotine pouches are gaining attention as another option in the cessation toolbox.

In fact, Public Health Ontario recently dedicated a CME-accredited Rounds to the evolving nicotine-pouch landscape in Canada, examining how they’re regulated, marketed and sold, along with emerging research on health effects and their potential usefulness for smoking cessation.

Their emergence adds another choice to an already crowded cessation toolbox and raises a practical question for physicians: with so many options available, what works best for whom?

Health Canada divides NRT into long- and short-acting options. The patch provides a steady dose of nicotine throughout the day, while gum, lozenges, inhalers, sprays and authorized nicotine pouches can help manage cravings as they occur.

That difference matters because nicotine withdrawal isn't just about cravings. Irritability, low mood and difficulty concentrating can all make quitting harder. As CAMH explains, the patch can reduce withdrawal by providing nicotine slowly over hours. Short-acting NRT reaches the brain more quickly, although still far more slowly and at lower levels than nicotine from cigarettes.

The evidence also supports using the two approaches together. A Cochrane systematic review of 68 studies involving more than 43,000 participants found similar long-term quit rates with patches and fast-acting NRT when used alone. Combining a patch with a fast-acting option, however, made quitting about 27% more likely than using a single form (95% CI: 17% to 37%). The review rated this as high-certainty evidence.

Authorized nicotine pouches add another short-acting option. Placed between the gum and cheek, they deliver nicotine through the oral mucosa without tobacco. Health Canada recognizes authorized nicotine pouches containing 4 mg or less as a non-prescription NRT dosage form for adults 18 and older.

But the evidence is still evolving. A 2025 systematic review of randomized trials found that nicotine pouches may reduce cigarette consumption and cravings, although it did not find statistically significant evidence of increased smoking-cessation rates compared with other products or controls.

That leaves room to tailor treatment to the patient rather than taking a one-size-fits-all approach. CAMH recommends considering a patient's needs and preferences when choosing a medication, along with what has and hasn't worked during previous quit attempts. NRT can also be one part of a broader plan that includes prescription therapy and counselling.

The takeaway: there may not be one NRT that works for everyone. More options give physicians more ways to find an approach that works for the patient in front of them.

1: 🤖 Thinking about using AI? Your patients may judge you for it. In a new study, 1,030 US adults rated fictional family doctors who said they used AI for diagnosis and treatment as less warm and less competent than doctors who said they never used it. They were also less willing to book an appointment, follow the doctor's treatment plan or recommend them to others. Interestingly, the AI penalty was even stronger among participants under 45. The study used hypothetical physician profiles, not real-world visits, but suggests AI adoption may come with a patient-perception problem.

💬 Your turn: Do you tell patients when you use AI? Join the conversation on r/Postcall.

2:🤰Health Canada has recalled hCG One Step Pregnancy Tests because they may detect low levels of hCG below the stated assay sensitivity, potentially resulting in false-positive results in non-pregnant people. The package insert is being updated to reflect that low hCG levels can occur at or after onset of perimenopause. Hopefully, this keeps "One Step" from turning into several unnecessary ones.

3: ✈️ Got NEXUS on your travel list? You may have to cross it out sooner. Starting next April, Canadians who are conditionally approved for NEXUS will have 2 years to schedule their enrolment interview, down from 5. The longer window was a pandemic-era measure, and border officials say increased interview capacity means it's no longer needed. Already conditionally approved? You'll have 5 years from your approval date or until April 1, 2029, whichever comes first. Here's what travellers need to know.

Retinoids are often an important part of a treatment plan for patients with acne. Still, the prescription is only one piece of the routine. When skin feels dry, tight or uncomfortable, the questions tend to follow: What should they cleanse with? Should they moisturize? What else can support the routine?

A published Canadian study examined a ceramide-containing Hydrating Cream-to-Foam Cleanser and Facial Moisturizing Lotion used alongside topical retinoids. In this 3-minute video abstract, see how the routine was evaluated for treatment-related side effects and tolerability.

6.5 mmHg: how much an unsupported arm can inflate a systolic blood pressure reading. In one study, letting the arm hang at your side pushed readings nearly 7 points higher than proper positioning. The textbooks were right: ideally, the cuff is at mid-heart level, and the forearm is resting on a surface.

5: the number of wavelengths it took to tell disease-linked body odours apart. Researchers used lasers to analyze swabs from people with Parkinson's, COVID-19 and mild cognitive impairment, finding distinct patterns compared with healthy participants. The study involved just 24 people, so we're a long way from diagnosis by sniff test, but your body odour may be giving away more than you think.

91: the age of the oldest person to hike the Appalachian Trail. Despite falling 71 times, the man completed the more than 3,000-kilometre trek. His advice for any senior attempting to follow in his footsteps? Exercise and don’t be afraid to eat donuts!

🥘 Make: dinner while doing almost nothing. Serious Eats just rounded up its most-saved slow-cooker recipes, including creamy beef stroganoff, pork ragù and chicken tacos. 

🩺 Learn: how to make viral hepatitis screening part of routine primary care. This free 15-minute course covers who to screen, which tests to order and practical ways to work screening into your existing workflow. Plus, earn 0.25 Mainpro+ credits while you’re at it.

✈️ Escape: somewhere new without a connection. New direct routes from Canada include Tenerife from Toronto and Montreal, plus new destinations including Sicily, Mallorca and Bangkok. Service from Toronto to Tenerife starts Oct. 25, timed perfectly for some winter-trip dreaming. 

🎥 Watch: which specialties are the least competitive in 2026. Med School Insiders breaks down the 5 specialties using the latest data, including what it takes to be a competitive applicant.

First clue: What you look for on doppler ultrasound of the lower extremities

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